Upper Bleph + Under Eye Filler? (Photo)

The desire to look better is natural and understandable. When you consult my colleagues, irrespective of their particular speciality ( oculoplastics, facial plastics, general plastics, or dermatology), more than likely they will not understand your objective. You won't be alone. Lets be honest, your goal in considering these procedures is to be transformed into a more beautiful self. This is basically the mythic quest of anyone seeking aesthetic surgery and services. Accomplishing this goal should be the mission of any potential surgeon you see but that is sadly not how things work. When you ask for an upper blepharoplasty, more than likely they will not even examine your eyelids. I know because I fix so many eyelids after unsatisfactory eyelid surgery. Instead they will speak to you and tell you that you are a great candidate for eyelid surgery and fillers. That is unfortunate because the examination of the eyelids is very important. If they actually examined your eyes they might discover that you have early upper eyelid ptosis with a compensatory eyebrow elevation. The basis for the mild upper eyelid ptosis is partial central levator aponeurosis disinsertion with loss of a hard upper eyelid crease (accounts for the slight looseness of the upper eyelid platform skin. Assuming you have not reversed your images (very common) you hold your left eyebrow slightly higher than the right. What happens all too commonly with upper blepharoplasty is that the incision is placed at the natural crease but that will be too high. In some cases that could be between 10 and 14 mm. Combined with a failure to recognize the evolving levator disinsertion, the upper eyelid will look hollow and skeletonized. More so when upper eyelid fat and skin are removed even when done "conservatively." Upper fold volume makes up look youthful. Then the fold is removed by the well meaning eyelid surgeon you will shocked and disappointed by the result. It will make you look older rather than transformed. What you need is a very thoughtful upper eyelid reconstruction with a low new crease at 6 or 7 mm with a repair of the disinserting levator disinsertion. This is very similar to an anterior levator ptosis repair but you really do not need much of any ptosis repair, rather you need the tendon to have a strong attachment to the upper eyelid tarsus. The eyelid platform skin length is carefully adjusted to snug this skin to the new hard upper eyelid crease. The amount of post operative eyelid platform skin is not something that should be left to the discretion of the surgeon. You need to have an explicit conversation with your potential surgeon about the design of this. Currently this is not uniform but if there is too much eyelid platform exposure under the fold edge you will be very unhappy. Generally I recommend something in the 2.5 to 3 mm range so you have a place to hold make up. More than this begins to look excessive. With stabilization of the upper eyelid tendon, the eyebrows will relax and look for serene and relaxed which is understood as more youthful. I do think you could benefit from undereye filler-less is more. Only use Restylane for this location. It is a fussy service that is worth traveling for. If you are using a lash growth serum (Latisse, isopropyl cloprostenate, Jamaican castor bean oil) are harmful to the upper eyelid fat-please don't these products. Hope this helps.

It appears that conservative upper blepharoplasty may benefit you. Considering lower eyelids, it has been our experience in the past 20 years that combination of micro and nano fat grafts works better than fillers. Hope this helps.